ICU呼吸机相关性肺炎患者病原菌分布与耐药性分析  

Distribution and drug resistance of pathogens isolated from patients with ventilator-associated pneumonia in ICU

作　　者：李福琴[1] 杨阳[1] 张梦华[1] 李俊艳[1] 刘彩虹[1] 刘盛楠[1] 敖娟[1] 

机构地区：[1]郑州大学第一附属医院感染管理科,河南郑州450052

出　　处：《中华医院感染学杂志》2016年第11期2497-2499,共3页Chinese Journal of Nosocomiology

基　　金：河南省科技攻关计划基金资助项目(162102310155)

摘　　要：目的探讨医院重症监护病房(ICU)呼吸机相关性肺炎(VAP)患者病原菌分布及其耐药性,指导临床合理用药。方法回顾性分析2014年1月-2015年12月医院ICU 7 195例呼吸机使用患者临床资料,调查其VAP发生率,分析痰培养及药敏试验结果。结果确诊VAP患者505例,日感染率为14.30‰;ICU中VAP患者共检出病原菌1 052株,主要以革兰阴性菌为主,前4位的病原菌依次为鲍氏不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和金黄色葡萄球菌,分别占34.79%、21.86%、12.26%和9.70%;药敏试验结果表明,鲍氏不动杆菌对常用抗菌药物的耐药性较为严重,肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌对头孢他啶和亚胺培南的耐药率低于其他常用抗菌药物,未发现耐万古霉素和利奈唑胺药的耐甲氧西林金黄色葡菌球菌。结论 ICU中VAP患者感染病原菌以革兰阴性菌为主,掌握病原菌的耐药特点,为临床科学选择抗菌药物提供参考依据。OBJECTIVE To explore the distribution and drug resistance of pathogens isolated from patients with ventilator-associated pneumonia（VAP）in intensive care unit（ICU）so as to provide guidance for reasonable clinical use of antibiotics.METHODS A total of 7 195 patients who were treated with ventilators in ICUs from Jan 2014 to Dec 2015 were enrolled in the study,the clinical data of the enrolled patients were retrospectively analyzed,the incidence of VAP was investigated,and the results of the sputum culture and drug susceptibility testing were observed.RESULTS Totally 505 patients were diagnosed with VAP,and the daily infection rate was 14.30‰.A total of 1 052 strains of pathogens were isolated from the VAP patients in the ICUs,among which the gram-negative bacteria were dominant.The Acinetobacter baumannii,Klebsiella pneumoniae,Pseudomonas aeruginosa,and Staphylococcus aureus ranked the top 4species of pathogens,accounting for 34.79%,21.86%,12.26%,and9.70%,respectively.The result of drug susceptibility testing indicated that the A.baumannii was highly resistant to the commonly used antibiotics,the drug resistance rates of the K.pneumoniae,P.aeruginosa,and Escherichia coli were lower to ceftazidime and imipenem than to other commonly used antibiotics,and the vancomycin-or linezolid-resistant methicillin-resistant Staphylococcus aureus was not found.CONCLUSIONThe gram-negative bacteria are dominant among the pathogens causing infections in the VAP patients in the ICUs.It is necessary to grasp the characteristics of drug resistance of the pathogens so as to provide scientific basis for clinical use of antibiotics.

关 键 词：重症监护病房 呼吸机相关性肺炎 患者 病原菌 耐药率 

分 类 号：R459.7[医药卫生—急诊医学]